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Five states demand small payments from those who gained coverage under the Affordable Care Act’s Medicaid expansion, but enrollees often face few consequences if they don’t make their remittances. (Phil Galewitz,
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Summaries Of The News:

In a televised session on Wednesday, President Donald Trump signaled support on everything from expanded background checks, increased school security and mental health resources, and age limits. Trump also suggested that law enforcement officials should be able to confiscate people's firearms without a court order.

The New York Times:
Trump Stuns Lawmakers With Seeming Embrace Of Gun Control
President Trump stunned Republicans on live television Wednesday by embracing gun control and urging a group of lawmakers at the White House to resurrect gun safety legislation that has been opposed for years by the powerful National Rifle Association and the vast majority of his party. In a remarkable meeting, the president veered wildly from the N.R.A. playbook in front of giddy Democrats and stone-faced Republicans. He called for comprehensive gun control legislation that would expand background checks to weapons purchased at gun shows and on the internet, keep guns from mentally ill people, secure schools and restrict gun sales for some young adults. He even suggested a conversation on an assault weapons ban. (Shear, 2/28)

The Associated Press:
Trump Says Some Lawmakers Too Fearful Of NRA To Take Action
"We can't wait and play games and nothing gets done," Trump said as he opened the session with 17 House and Senate lawmakers. "We want to stop the problems." Trump also raised eyebrows by suggesting that law enforcement officials should be able to confiscate people's firearms without a court order to prevent potential tragedies. (Mascaro, Daly and Lucey, 3/1)

The Washington Post:
Trump Surprises Lawmakers In Backing Some Tougher Gun Controls
Most striking were Trump’s remarks decrying what he called excessive “checks and balances” that limit what can be done to prevent mentally unfit people from buying or keeping guns. “Take the firearms first, and then go to court,” Trump said, cutting off Vice President Pence as Pence articulated a version of the due-process arguments that the NRA and other gun-rights advocates have used to derail past gun-control measures. “You could do exactly what you’re saying, but take the guns first, go through due process second.” (Gearan, DeBonis and Kim, 2/28)

The Wall Street Journal:
Trump Urges Congress To Take Action On Guns
“If this meeting ends up with just sort of vague notions of future compromise, then nothing will happen,” said Sen. Chris Murphy (D., Conn.). “Mr. President, it’s going to have to be you that brings the Republicans to the table on this.” “I like that responsibility,” Mr. Trump replied. (Radnofsky, Peterson and Andrews, 2/28)

The CT Mirror:
Trump Asks Murphy To Help Draft 'Comprehensive' Gun Bill
President Donald Trump on Wednesday said he wanted Sen. Chris Murphy to join three Senate colleagues – John Cornyn, R-Texas; Joe Manchin, D-W.Va.; and Pat Toomey, R-Pa., in drafting a “comprehensive” gun bill that is “very powerful” on expansion of the FBI background check system for gun buyers. “We are determined to turn grief into action,” Trump said at a White House gathering with lawmakers to discuss ways to combat gun violence. (Radelat, 2/28)

Politico:
Why Hardening Schools Hasn't Stopped School Shootings
President Donald Trump has called for “hardened schools” to end the cycle of school massacres. But he was unimpressed last week when told about a Midwestern campus dubbed "the safest school in America." An Indiana state official had suggested he consider Southwestern High in Shelbyville a national prototype because of its state-of-the-art cameras that send real-time footage to a sheriff’s office, smoke cannons in hallways, bulletproof doors and teachers who wear panic buttons. (Emma, 3/1)

Sacramento Bee:
California Bill Raises Age Limit To Buy Guns
A state senator is pushing a bill to raise the minimum age to legally purchase rifles and shotguns in California to 21. Sen. Anthony Portantino, D-La Cañada Flintridge, amended Senate Bill 1100 on Wednesday to prohibit someone from purchasing more than one gun in 30 days and to increase the age limit to buy all firearms to 21. (Luna, 2/28)

The New York Times:
Even After High School Massacre, Albany Demurs On Gun Control
It was, especially in a restrictive state like New York, a seemingly modest set of gun-control proposals. Prospective gun buyers would undergo longer background checks; an institute would be formed to study gun violence; courts would be allowed to seize or prohibit the sale of guns to potentially violent individuals; and a ban would be enacted on the possession of bump stocks, which can make a semiautomatic rifle shoot nearly as fast as a fully automatic version. (McKinley, 2/28)

A 1996 amendment prohibits the CDC from using funds to advocate for or promote gun control; while the language in the measure didn’t expressly prevent scientific research, it was ambiguous and the agency sharply curbed its research into gun violence. Meanwhile, advocates are taking advantage of the spotlight directed toward mental health to call attention to gaps in the system.

The Wall Street Journal:
School Killings Spur Effort To Renew Government Gun-Violence Research
For more than 20 years, federal law has effectively halted the government’s ability to research gun violence. Now, the shooting that killed 17 at a Florida high school in February has prompted a bipartisan group of lawmakers to take another look at the restrictions. As lawmakers tangle over other gun-violence prevention measures, Democrats and some centrist Republicans are pushing to eliminate a provision tucked into spending bills that has restricted the Centers for Disease Control and Prevention’s ability to conduct research on the topic. (Peterson, McKay and Armour, 2/28)

The Hill:
Mental Groups Push For Policy Changes After Shooting
Mental health advocates are seizing on the new spotlight on their issue after the Florida shooting, as President Trump and congressional Republicans focus on mental health as a solution to gun violence. Some mental health groups want to use the renewed attention on mental illness to push for more resources to address what they see as major gaps in the country’s mental health system. (Weixel, 3/1)

In other news —

The Wall Street Journal:
In Columbine’s School District, Former Students Are Tracked To Prevent Attacks
After a former student shot two eighth-graders in 2010 in the same Colorado school district where the Columbine massacre took place, the district’s security chief John McDonald sought a way to thwart attacks by alumni. Mr. McDonald decided that the Jefferson County school district would treat former students who pose a threat the same way it treats current students. A case manager would be assigned to talk with them regularly, monitor their social media and check in with their therapists—even sometimes for years after they’ve graduated or left the school. (Elinson, 2/28)

Bloomberg:
NRA Reduces Gun Injuries For These Three Days Every Year, Research Shows
Like clockwork, the National Rifle Association reduces gun injuries in the US for three days every year -- when it holds its annual convention. Authors of a Harvard Medical School report published in the New England Journal of Medicine examined the “natural experiment” that occurs when about 80,000 NRA members hole up in a conference center. The finding: a 20 percent drop in injuries inflicted by the weapons compared to the same days of the week in the three weeks before and after the event. (Cortez, 2/28)

The moves by the companies come as other major corporations have been distancing themselves from the NRA after the mass school shooting in Florida.

The New York Times:
Walmart And Dick’s Raise Minimum Age For Gun Buyers To 21
Two of the nation’s leading gun sellers, Walmart and Dick’s Sporting Goods, took steps on Wednesday to limit their sales of firearms, thrusting themselves into the middle of the polarizing national debate over gun control. Walmart, the biggest gun seller, announced late in the afternoon that it would not sell any gun to anyone under 21 years of age. It also said it would no longer sell items resembling assault-style rifles, including toys and air guns. (Creswell and Corkery, 2/28)

The Wall Street Journal:
CEOs Choose Sides On Gun Control At Their Own Risk
It’s the newest question facing CEOs: Should they thrust their businesses into polarizing political debates? In the two weeks since a gunman killed 17 people at a Parkland, Fla., high school, many companies have taken a stand on gun control, prompted partly by a movement with the online rallying cry #NRABoycott. But when companies take sides in a charged issue, they often have to grapple with a new set of risks to their reputation and business, not least the risk of offending a sizable portion of consumers on the other side. (Fuhrmans and Feintzeig, 2/28)

While the process would be complex, the end result would be simple: It would allow Republicans to fund the insurer cost-sharing reductions without having to find a way to pay for them. In other health law news, an analysis projects that the administration's expansion of association plans will lead to 4.3 million people leaving the individual and small-group insurance markets.

The Hill:
GOP Eyes Budget Maneuver To Pay For ObamaCare Funds
Republicans are weighing whether to use a complicated budget maneuver to help pay for additional ObamaCare funding, sources say. The idea being considered by House Republican leaders is controversial because it would help fund key ObamaCare payments, something that many conservatives decry as a "bailout" of the law. Under the possible plan, the Budget Committee would direct the Congressional Budget Office (CBO) to take ObamaCare payments known as cost-sharing reductions (CSRs) out of its “baseline” for projecting federal spending. Essentially, the agency would stop assuming that the ObamaCare payments would be made. (Sullivan, 3/1)

Modern Healthcare:
Association Health Plans Could Spark 4.3 Million People To Drop ACA Coverage
As many as 4.3 million people are projected to leave the individual and small group insurance markets to enroll in association health plans over the next five years if the Trump administration's recent proposal to expand those plans is approved, according to a new analysis. As healthy, young people switch to association plans, premiums in the ACA individual and small group would rise as much as 4% between 2018 and 2022, according to healthcare consulting firm Avalere Health. Because of those premium increases, Avalere projected that another 130,000 to 140,000 people would become uninsured in five years, compared to current law. The study was funded by insurance industry lobbying group America's Health Insurance Plans, but Avalere said it maintained full editorial control. (Livingston, 2/28)

Kaiser Health News:
ACA’s Popularity Grows, Even As GOP Lauds Change To Requirement To Have Coverage
Despite President Donald Trump’s boasting that “we have essentially repealed Obamacare,” a new poll shows the Affordable Care Act is more popular than ever. In fact, many people don’t know Congress repealed the ACA’s penalty for not having insurance. The poll from the Kaiser Family Foundation found 54 percent of Americans had a favorable view of the 2010 health law that expanded health coverage to millions. That was up four points from January, and it’s highest point since the monthly survey began in 2010. (Galewitz, 3/1)

And in news from the states —

CQ:
States Weigh Response To Proposed Short-Term Health Plan Rule
The Trump administration proposal to increase how long consumers can maintain a short-term health insurance policy offers states an opportunity to rebel or endorse the policy. While officials in some states are looking to reject the administration’s proposed rule that would allow individuals to be covered by a short-term, limited duration health plan for 364 days, lawmakers in other states have sought to codify the proposal in state law. Some states already have limitations on short-term policies, which are not required to meet certain federal requirements, that would limit the effects of a rule in their markets. (McIntire, 3/1)

Denver Post:
Trump Wants To Expand Short-Term Health Insurance Plans. That Could Hit Some Coloradans In The Wallet, According To A New Report
Premiums for people in Colorado who buy health insurance on their own could rise substantially again next year, this time as the result of a recent Trump administration proposal to expand short-term coverage, according to a report released Tuesday. Short-term plans are exempt from the rules of the Affordable Care Act, meaning that they often cost — and cover — a lot less than longer-term plans. The Trump proposal would allow short-term plans to last an entire year, creating a cheaper option for healthy people who don’t need the Affordable Care Act’s protections for pre-existing conditions or other guaranteed benefits. In the Obama administration, the plans were limited to covering only three months at a time. (Ingold, 2/28)

The Hill:
Scott Walker Signs Bill Aimed At Stabilizing ObamaCare Market
Gov. Scott Walker (Wis.), a Republican who has been one of ObamaCare's most vocal opponents, signed a bill Tuesday that would shore up the law's insurance markets. The bill would authorize the state to apply for a federal waiver to offer a reinsurance program covering 80 percent of medical claims costing between $50,000 and $250,000. (Hellmann, 2/28)

Stat:
Pharma And The Patent System: Will Trump's Appointee Bring Change?
The newly installed director of the Patent and Trademark Office, the soft-spoken Andrei Iancu, could rein in drug makers in more direct fashion than perhaps any other individual in Washington. Unlike the others, he holds substantial sway over an intellectual property system that, critics say, has allowed drug makers to extend their monopolies through legal but questionable tactics — by making slight modifications to products and then filing for new patents, for example, or by working to curtail quicker challenges to their patent in favor of longer, drawn-out litigation in the courts. (Mershon, 3/1)

Stat:
Drug Makers Are Seeking More Orphan Designations Than Ever Before
Orphan drugs may target small patient populations, but they continue to rack up big numbers at the Food and Drug Administration. Last year, the agency issued a record-breaking 77 orphan drug approvals, far exceeding the previous annual high of 49 approvals notched in 2014. At the same time, the FDA agreed to award a stunning 476 orphan designations, well above the 355 designations made in 2015, which was the previous record total. And there were 526 designation requests last year, second only to the record of 582 made in 2016. (Silverman, 2/28)

Stat:
Under Trump, The Pace Of FDA Regulations Slowed To A Trickle
As the Trump administration settled in last year, the White House insisted on fewer regulations — and the Food and Drug Administration delivered, according to a new analysis. Last year, regulatory actions taken by the agency were only a fraction of the number of actions taken during the Obama administration and in fact dropped to the lowest level of any time in the past 20 years, according to the Health Research Institute at PricewaterhouseCoopers, the consulting firm. (Silverman, 2/28)

The Associated Press:
‘Pharma Bro’ Asks Judge For Leniency, Saying He Was A Fool
“Pharma Bro” Martin Shkreli admitted that he was “very far from blameless” in a letter to a judge asking for leniency, according to court filings. “I was wrong, I was a fool. I should have known better,” Shkreli wrote in his letter to Brooklyn federal court Judge Kiyo Matsumoto. “I accept the fact that I made serious mistakes, but I still believe that I am a good person with much potential,” Shkreli said. (2/28)

Reuters:
Doctor Admits Disclosing Patient Info To Drugmaker Aegerion
A Georgia pediatric cardiologist pleaded guilty on Wednesday to wrongfully disclosing information about his young patients to an Aegerion Pharmaceuticals Inc sales representative seeking to identify potential new users of an expensive cholesterol drug. Dr. Eduardo Montana, 55, entered his plea in federal court in Boston after Aegerion, a unit of Novelion Therapeutics Inc, agreed in September to pay $40.1 million to resolve U.S. investigations related to its marketing of the drug, Juxtapid. (Raymond, 2/28)

Stat:
Is Celgene The Biotech That Couldn't Shoot Straight?
In a stunning setback for Celgene (CELG), the Food and Drug Administration has refused to review a drug that the biotech has been testing for multiple sclerosis because of “incomplete” pharmacology data. The move is deeply significant: Not only is the medicine the most important product in the Celgene pipeline, but the refusal is the latest in a series of shocks that has unnerved investors over the past few months. Just last month, for instance, Celgene executives signaled that FDA approval for the drug, called orzanimod, was expected by the end of this year. Last October, the company unexpectedly halted development of another drug for combating Crohn’s disease, and then shortly afterward made deep cuts to its long-term financial guidance, moves that sent its shares plunging. (Silverman, 2/28)

Doctors who get in trouble in one state can just move on to another, and often practice free and clear despite having been publicly disciplined, chastised or barred from practicing by state medical boards.

Documents released by the ACLU show the decisions were made informally by email, memos and conversations rather than going through the normal legal process.

Politico:
Trump's Abortion Policy Sheds Light On Ad Hoc Decision-Making
The Trump administration’s policy of halting abortions among undocumented minors was established by email through an ad hoc process without formal legal vetting, according to new documents released Tuesday by the American Civil Liberties Union. The ACLU, which is suing the administration over the policy, made public the December depositions of the director and the deputy director of the Office of Refugee Resettlement, the HHS office responsible for the care of undocumented minors who enter the country without their parents. (Rayasam, 2/28)

Meanwhile, in Indiana —

The Associated Press:
Indiana House Passes Abortion Information Bill
A doctor who treats a woman for complications arising from an abortion would have to report new and more detailed information about the patient to the state, under a bill approved by the Indiana House on Wednesday. Though the bill is not as expansive as abortion laws passed in recent years — some of which have been thrown out in court — the debate unfolded along familiar lines. (Slodysko, 2/28)

President Donald Trump plans to discuss the national epidemic with administration officials on Thursday, following this week's Capitol Hill hearings, about ways to curb the crisis. But advocates on the front lines are struggling with deep funding challenges.

NPR:
State Opioid Efforts Falter Without Federal Funding Support
Opioids are on the White House agenda Thursday — President Trump plans to talk with members of his administration about the crisis. Meanwhile, all around the United States, state legislators, treatment providers, families and many others will be listening. The administration's other opioid efforts have, so far, yielded no new money. Congress authorized funds in its recent budget deal — but those dollars aren't flowing yet, and states say they are struggling. (Daley and Fortier, 3/1)

CQ:
House Panel Debates Opioid Bills
The House Energy and Commerce Health Subcommittee kicked off debate Wednesday on eight bills addressing opioid abuse that were focused on the enforcement of controlled substances and patient safety. While five of the bills were bipartisan, a few bills generated hot debates. Earlier this month, Energy and Commerce Chairman Greg Walden, R-Ore., called addressing the epidemic a top legislative priority for the year. He noted during the hearing that opioid overdose deaths were five times higher than in 1999. (Raman, 2/28)

The Hill:
Dem Urges DEA To Release Data On Opioid Distributors
A Democratic lawmaker is urging the Drug Enforcement Administration (DEA) to release data on the distribution of opioids across the country to those involved in hundreds of lawsuits against opioid manufacturers and distributors. “I would just encourage the DEA to be as responsive as possible,” Rep. Kathy Castor (D-Fla.) told a DEA official during a House Energy and Commerce health subcommittee hearing Wednesday. (Roubein, 2/28)

And in other news —

Health News Florida:
Needle Exchange Program Could Expand In South Florida
An effort to expand a needle-exchange program statewide was scrapped Tuesday by a House health care committee, which agreed to extend the Miami-Dade County program to two additional Southeast Florida counties. “In the spirit of baby steps, I encourage you to support this,” Rep. Cary Pigman, R-Avon Park, told members of the House Health & Human Services Committee. (2/28)

The number of people who were paying out of pocket for transgender surgeries plummeted to 39 percent between 2012 and 2014. Now, virtually every major medical association in the United States has described transition-related surgeries as “medically necessary.”

The Washington Post:
Transgender Surgeries Are On The Rise, Says First Study Of Its Kind
In the first broad demographic study of trends in gender-affirming surgeries in the United States, researchers found that the number of operations increased fourfold from 2000 to 2014. Some of the significant rise, according to a study published Wednesday in the journal JAMA Surgery, may be related to an increase in insurance coverage for the procedures. “Early on we recognized there’s been a lot of work on health disparities having to do with age, race and so on that get collected in health-care settings,” said Brandyn Lau, an assistant professor of surgery and health sciences informatics at the Johns Hopkins University School of Medicine. “One of the things we need to know is whether [lesbian, gay and transgender] patients are getting the same care.” (Nutt, 2/28)

The Baltimore Sun:
More People Getting Gender Reassignment Surgery
Those who work with transgender patients said the results of the Johns Hopkins study show that the health care industry is slowly becoming more sensitive to the needs of these patients. Jody Herman, a scholar with The Williams Institute, said that more researchers are using medical records from Medicare, Medicaid and private insurers to try to glean a better picture of the health of transgender people. (McDaniels, 2/28)

In other news —

The Associated Press:
TV Ad Aims To Pressure Trump On Transgender Military Service
Activist groups are turning to television ads — including on President Donald Trump's go-to station, Fox News — to pressure the White House into allowing transgender people to keep serving in the military. Trump has vowed to ban transgender troops from serving. He'll be able to see the 30-second commercial as of Friday, when it starts airing on Fox, CNN and MSNBC morning shows. It uses a series of quotes from Trump, a former senior military leader and several Congress members who were in the armed forces to argue that all qualified Americans should be able to serve. (Baldor, 3/1)

Three-quarters of this year's pediatric flu deaths were in children who did not have a flu shot. In other public health news: eye health, c-sections, the "obesity paradox," diet soda, the cosmetics industry and hydration.

Los Angeles Times:
In A Deadly Season, A Grieving Mother Who Lost A Child To The Flu Fights Back
Scarlet Anne died during one of the worst influenza seasons in the country in years, and Hendricks struggled to make sense of her daughter's death. ... So in 2015, the year after Scarlet Anne died, the Tacoma, Wash., mother founded the Fight the Flu Foundation, an organization dedicated to raising awareness about the seriousness of the flu, especially for families and children. The group since has gained official nonprofit status as The End-FLUenza Project. (Simmons, 2/27)

Bloomberg:
Scientists Want To Completely Rethink How They Make The Flu Vaccine
The only thing worse than getting the flu is catching it after you’ve gotten a flu shot. It’s been a terrible year for outbreaks — the worst in almost a decade. Contributing to that is the high failure rate of this year’s vaccine. The current shot is just 25 percent effective against the H3N2 virus, this season’s most-often-identified strain by the Centers for Disease Control and Prevention. The experts say, with enough time and money, they can do a lot better. “There has to be a wholesale change to how we make the flu vaccine,” said Amesh Adalja, senior scholar at Johns Hopkins Center for Health Security. “We’re always setting ourselves up for vaccine mismatch and failures and the like because of the lead time in how long it takes the vaccines to be made.” (Koons and Levingston, 2/28)

CNN:
7 Health Problems Predicted With A Look Into Your Eyes
More proof that the eyes reflect overall health just arrived in the form of a study adding a disease to the list of what can be predicted by examining "the windows to the soul." Small changes in the blood vessels within our eyes at age 60 can foretell a significant loss of memory over the next couple of decades, suggests a study published Wednesday in the medical journal Neurology. (Scutti, 2/28)

The New York Times:
C-Sections And Gut Bacteria May Contribute To Overweight Kids
Overweight mothers are more likely to have overweight babies, and the gut bacteria the babies inherit may in part be to blame. Researchers report that overweight mothers are more likely to have a cesarean section, and that babies born by cesarean to those mothers have species of gut bacteria different from those in babies born to normal weight women. And that difference in the gut microbiome — specifically an abundance of bacteria of the family Lachnospiraceae in infants of overweight mothers — may contribute to an increased risk for obesity. (Bakalar, 2/28)

The New York Times:
‘Obesity Paradox’ Fails To Hold Up In Study
Some experts have suggested that there is an “obesity paradox,” the idea that obese people live longer than those of normal weight. But a new study found that obesity was associated with an increased risk for cardiovascular disease and a two- to three-year shorter life span. The study, in JAMA Cardiology, pooled data from 10 studies of 190,672 people followed from 1964 to 2015. Compared with those of normal weight, overweight men (body mass index of 25 to 29.9) had a 21 percent higher lifetime risk of cardiovascular disease and women a 32 percent higher risk. (Bakalar, 2/28)

Reuters:
Coca-Cola Defeats U.S. Lawsuit Over Diet Coke Ads
A federal judge has dismissed a lawsuit claiming that Coca-Cola Co's advertising for Diet Coke misleads people into thinking that consuming the soft drink assists in weight loss, and that it actually causes weight gain. The plaintiff, Shana Becerra, claimed that she and others would not have bought Diet Coke, which was launched in 1982, but for the word "diet" and ads such as one showing the soft drink being poured by a bare-chested man with a well-muscled torso. (Stempel, 2/28)

The Wall Street Journal:
The Cosmetics Industry May Get A Regulatory Makeover
At a time when Washington is pushing to deregulate industry, a congressional effort is under way to intensify federal regulation over cosmetics and personal-care products for the first time in 80 years. Senate staffers from both parties have reached a tentative agreement to stiffen oversight of safety standards for beauty products including skin creams, deodorants, hair dyes, shampoo and mascara, which until now have only been lightly regulated by the Food and Drug Administration. (Burton, 3/1)

The New York Times:
You Get Thirsty And Drink. How Does Your Brain Signal You’ve Had Enough?
If you think about being thirsty at all, it seems like a fairly simple thought process: Find water. Drink it. Move on. But in fact there is something rather profound going on as you take that long, refreshing drink after a run or a hot day in the garden. As you become dehydrated, there is less water in your blood, and neurons in your brain send out the word that it’s time to look for water. (Greenwood, 2/28)

Kaiser Health News:
Never Too Late To Operate? Surgery Near End Of Life Is Common, Costly
At 87, Maxine Stanich cared more about improving the quality of her life than prolonging it. She suffered from a long list of health problems, including heart failure and chronic lung disease that could leave her gasping for breath.When her time came, she wanted to die a natural death, Stanich told her daughter, and signed a “do not resuscitate” directive, or DNR, ordering doctors not to revive her should her heart stop. (Szabo, 2/28)

Hospitals tend to be cornerstone institutions in rural communities, but many of them, under financial stress, are closing. Meanwhile, Community Health Systems' stock dropped amid reports of a $2 billion net loss in the fourth quarter.

NPR:
Many Rural Hospitals Must Adapt Or Close, Economics Suggest
Heidi Schultz grew up traveling from one end of South Dakota to the other, tagging along as her sister saw doctors and specialists in the "big cities" to treat her diabetes. Schultz thought she knew rural America well when she took a position as a rural health care program officer for the Helmsley Charitable Trust in Wyoming and Montana. But even she has been surprised by how she can drive hours on country highways seeing few cars and just "a handful of gravel driveways going somewhere you can't see." (St. Clair, 2/28)

Modern Healthcare:
Community Health Systems' Share Price Falls 17%
Community Health Systems' stock price fell 17% Wednesday following the previous day's release of results for 2017, including a $2 billion net loss in the fourth quarter. The company's executives chalked up the net loss to non-cash accounting changes that won't affect its future earnings or cash flows, though investors apparently weren't convinced. The Franklin, Tenn.-based hospital chain's stock price plunged after its investor call and finished the trading session down 17% at $5.12. The massive net loss, amounting to about $18 per share, was significantly wider than the $220 million net loss CHS reported in the fourth quarter of 2016. (Bannow, 2/28)

In other health industry news —

Bloomberg:
Collective Health Bets Employers Are Fed Up With Health Expenses
Collective Health Inc., a startup offering tech-savvy tools for managing health benefits, has raised a fresh infusion of investor cash as it seeks to win over more employers fed up with a fragmented, costly market. The San Francisco-based company, founded in 2013, is betting that growing dissatisfaction with rising health-care costs will lure more firms to its technology, which lets employers cut through the tangle of different benefits they typically administer. (Tracer, 2/28)

Bloomberg:
N.J.'s Horizon Blue Cross Sees $550 Million Benefit From Tax Law
Horizon Blue Cross Blue Shield of New Jersey, the state’s largest health insurer, said the new federal tax law will result in the company receiving $550 million of refunds over the next five years. The measure, enacted by President Donald Trump in 2017, eliminated the alternative minimum tax for businesses. As a result, Horizon can receive a refund for unused tax credits, the not-for-profit insurer said in a statement. (Sherman, 2/28)

Bloomberg:
Alphabet-Backed Startup Clover Health Posts $22 Million Loss In 2017
Clover Health, an insurance startup backed by Alphabet Inc., reduced its loss last year as the health-care company seeks to inch its way beyond its first market in New Jersey. Despite being one of the most richly valued health-tech startups in the U.S., Clover only offered insurance to seniors living in New Jersey, until a recent expansion to parts of Georgia, Pennsylvania and Texas. The New Jersey operation lost $22 million last year, an improvement from a $35 million loss in 2016, Clover said. Revenue grew to $267 million from $184 million. (Chapman, 3/1)

The restructuring of MassHealth is among the most significant health care initiatives to come from the administration of Gov. Charlie Baker, a Republican who has been focused on containing the costs of the massive program. In other Medicaid news: work requirements, premiums, and opioids.

Boston Globe:
Health Care Providers Brace For Confusion As New Mass. Medicaid Rules Are Rolled Out
More than 800,000 Massachusetts Medicaid recipients enter a new era Thursday with the rollout of sweeping changes that are designed to improve care and save money — but that could cause initial confusion and disruption. State officials are trying to more tightly control where patients on the Medicaid program, called MassHealth, receive their care. They have assigned patients to one of several different accountable care organizations — or networks of doctors and hospitals that will work to manage patients’ care. (Dayal McCluskey, 2/28)

Chicago Tribune:
Lawmakers Approve Revamp Of Hospital Medicaid Funding Program
A long-awaited redesign of a program for distributing Medicaid money to hospitals across Illinois was approved Wednesday by state lawmakers. Gov. Bruce Rauner is expected to sign the legislation, which revamps the $3.5 billion hospital assessment program that provides more than half of hospitals’ Medicaid funding. The federal Centers for Medicare & Medicaid Services must approve the program before the current policy sunsets June 30, though if that doesn’t happen in time there is a bridge provision in the legislation to extend the current policy until the new one gets federal approval. (Elejalde-Ruiz, 2/28)

Modern Healthcare:
Public Skeptical About Medicaid Work Requirement Rationale
The public isn't sold on the Trump administration's argument that letting states impose work requirements on Medicaid beneficiaries is intended to lift people out of poverty, according to a new Kaiser Family Foundation survey. Forty-one percent of people polled said the goal of the work requirements approved in Kentucky and Indiana and proposed by eight other GOP-led states is to reduce government spending, while 33% said it's to help people leave poverty, the latest Kaiser Health Tracking Poll found. Republicans were almost equally split, with 42% saying it's to cut spending and 40% saying it's to reduce poverty. (Meyer, 3/1)

Kaiser Health News:
Tens Of Thousands Of Medicaid Recipients Skip Paying New Premiums
When Arkansas lawmakers debated in 2016 whether to renew the state’s Medicaid expansion, many Republican lawmakers were swayed only if some of the 300,000 adults who gained coverage would have to start paying premiums. This “skin-in-the-game” provision — endorsed by conservatives in Washington and in many statehouses — is designed to make Medicaid recipients value their government health insurance more and lead healthier lives. It’s “to encourage more personal responsibility,” Arkansas Gov. Asa Hutchinson told reporters in 2016. “We want to incentivize better, healthy living.” (Galewitz, 3/1)

The Philadelphia Inquirer/Philly.com:
Gov. Wolf To Announce Medicaid Change Aimed At Opioid Treatment
In an effort to help people get faster treatment for opioid addiction, the state will remove a pre-authorization requirement for Medicaid recipients prescribed some types of medication helpful for recovery, Gov. Wolf is expected to announce Thursday. Pre-authorization can take up to 24 hours, and the administration hopes the change — which advocates have been calling for — will prevent situations where people struggling with addiction must decide whether to pay out of pocket for the medication, use drugs or risk going into painful withdrawal. (Madej, 2/28)

The Associated Press:
Rules For Backup Power For Nursing Homes Go To Florida House
A proposed rule requiring Florida nursing homes to have backup power in the event of an outage advanced Tuesday in the Florida Legislature. The proposal now heads to the full House after being passed Tuesday by that chamber's Health and Human Services Committee.It would require facilities to have a generator capable of keeping facilities at 81 degrees or lower for at least four days. It also requires them to keep 72 hours of fuel on site. (2/28)

Pioneer Press:
After Elder Abuse Complaints, Care Providers Offer Apologies And Solutions
As Minnesota works to improve protections for seniors and vulnerable adults, long-term care providers offered apologies for past abuses and ideas for improving safety. “To all the seniors and families whose lives have been impacted, in any way, by abuse or maltreatment, please know we share their hurt and their grief and are truly sorry for the heartbreaking experiences they have endured,” Gayle Kvenvold, CEO of LeadingAge, told members of the Senate aging and long-term care committee Wednesday. Kvenvold’s organization represents long-term care providers. She was one of 10 leaders from the long-term care sector to address lawmakers a week after family members detailed the abuse their relatives suffered in assisted living facilities. (Magan, 2/28)

The Associated Press:
State Worked To Shape Coverage Of Legionnaires' Outbreak
Email messages show Illinois officials worked to put a positive spin on news coverage as a deadly Legionnaires' disease outbreak first unfolded at a state veterans' home. Chicago's WBEZ obtained emails between state and local public health officials and the state agency that oversees the Illinois Veterans' Home in Quincy, where Legionnaires' has contributed to 13 deaths since 2015. Dozens more residents have been sickened, including several this year. (2/28)

The Washington Post:
Timothy Cunningham: Missing CDC Epidemiologist Passed Over For Promotion Before Disappearance
Police investigators are bewildered as they work through the “extremely unusual” circumstances surrounding the missing-person case of Timothy Cunningham, a researcher who vanished Feb. 12, shortly after hearing why he had been passed over for a promotion at the Centers for Disease Control and Prevention (CDC). Cunningham, 35, told colleagues he was not feeling well and left work at CDC headquarters in Atlanta, not long after speaking with his supervisor about why he had not been promoted, Atlanta Police Maj. Michael O'Connor told reporters. (Horton, 3/1)

The Associated Press:
Ted Kennedy Jr. Says He's Not Running For Connecticut Senate
Ted Kennedy Jr., son of the late Massachusetts senator, said Wednesday he will not seek a third term in the Connecticut Senate because he wants to focus on protecting disability rights, which he said are under "an enormous threat" at the federal level. The 56-year-old Democrat with the famous last name, who has been mentioned as a possible candidate for offices from governor to U.S. senator, said he feels compelled to play a bigger role in the disability rights community. (2/28)

Modern Healthcare:
Partners And Care New England Add Lifespan To Merger Talks
Providence, R.I.-based Lifespan has joined its neighboring system Care New England in proposed merger talks with Boston's Partners HealthCare. Tuesday's announcement adds a new wrinkle to the potential three-way deal as Partners, the largest healthcare provider in Massachusetts, looks to expand its reach into Rhode Island. The news came about a month after Brown University and California-based hospital company Prospect Medical Holdings intervened by pitching an unsolicited proposal to acquire Care New England if the talks with Partners fall through. (Kacik, 2/28)

Atlanta Journal Constitution:
Atlanta Homeless Receive Flu Vaccinations From Fulton Board Of Health
Because of a spike in influenza or “flu” activity in the United States in recent weeks, the Centers for Disease Control and Prevention has renewed its recommendation to get vaccinated against influenza. In response, the Fulton County Board of Health recently implemented a proactive strategy to help stop the spread of influenza among some of Fulton’s most vulnerable population – the homeless. (Miller, 2/28)

The Associated Press:
Hearing-Impaired Teen Inspires Virginia Sign Language Bill
Virginia high school students would be able to count American Sign Language as a foreign language credit beginning this fall under a bill that won approval from the General Assembly this week.House Bill 84, introduced by Del. Dickie Bell, R-Staunton, unanimously passed the Senate on Monday. Now it will go to Gov. Ralph Northam to be signed into law. Teenager Emma Chupp, who was selected to work as a Senate page — or legislator’s helper — this General Assembly session, suggested the idea for the bill. Chupp said she is enrolled in a high school Spanish class but finds the language challenging to learn because she is hard of hearing. (Spraggs, 2/28)

San Jose Mercury News:
California Has The Worst Quality Of Life, New Study Says
California dreamin’? Flying in the face of traditional wisdom that we live on the best coast comes a stinging new U.S. News & World Report study that says we have the worst quality of life in the nation. The coveted Best States ranking is part of an annual study that scores all 50 states on eight categories — health care, education, economy, opportunity, infrastructure, crime and corrections, fiscal stability and the most important of all for most of us, quality of life. (D'Souza, 2/28)

Arizona Republic:
Maricopa County Health District Will Buy, Renovate Maryvale Hospital.
The shuttered Maryvale Hospital in west Phoenix will be revived as an emergency department and behavioral health hospital under a $60.1 million deal approved Wednesday by the Maricopa Integrated Health System’s district board. MIHS agreed to purchase the hospital, located at 51st and Campbell avenues, from Tenet Healthcare for nearly $7.6 million and will spend $52.5 million to renovate and equip the aging building. (Alltucker, 2/28)

Austin Statesman:
Westlake Class Provides Students An Inside Look At Hospital Operations
The Health Science: Clinical class at Westlake High School isn’t your average class. ... One of the main purposes of the course is to give students an opportunity to figure out their career interests before entering college. t Seton Hospital, students may observe the nursery, x-ray department, ICU, and heart procedures and transplants, while at Westlake Hospital, students see multiple surgeries, and are allowed inside the E.R. (O'Bryon, 2/28)

The Star Tribune:
Minn. Patients Say Medical Pot Helps With Chronic Pain
A large share of Minnesotans using medical marijuana for chronic pain say they’re experiencing less discomfort and have reduced their reliance on potentially addictive opioid drugs. In the state’s first report card on cannabis and chronic pain, more than 60 percent of patients responding to a state survey said they benefited greatly from using pot in inhaled or pill forms, and 43 percent of their doctors concurred. (Olson, 3/1)

Each week, KHN's Shefali Luthra finds interesting reads from around the Web.

The Atlantic:
What I Saw Treating the Victims From Parkland Should Change the Debate on Guns
As I opened the CT scan last week to read the next case, I was baffled. The history simply read “gunshot wound.” I have been a radiologist in one of the busiest trauma centers in the United States for 13 years, and have diagnosed thousands of handgun injuries to the brain, lung, liver, spleen, bowel, and other vital organs. I thought that I knew all that I needed to know about gunshot wounds, but the specific pattern of injury on my computer screen was one that I had seen only once before. (Heather Sher, 2/22)

BuzzFeed:
The Inside Story Of How An Ivy League Food Scientist Turned Shoddy Data Into Viral Studies
In the summer of 2013, Özge Siğirci, a young scientist in Turkey, had not yet arrived at Cornell University for her new research stint. But she already had an assignment from her future boss, Brian Wansink: Find something interesting about all-you-can-eat buffets.As the head of Cornell’s prestigious food psychology research unit, the Food and Brand Lab, Wansink was a social science star. (Stephanie Lee, 2/25)

BuzzFeed:
Passengers Who Call Uber Instead Of An Ambulance Put Drivers At Risk
Ride-hail drivers are, by and large, untrained, self-employed workers driving their own cars on a part-time basis. They’re not medical professionals. But as health care costs have risen and ride-hail has become more pervasive, people are increasingly relying on Uber and Lyft drivers to get them to the hospital when they need emergency care. (Caroline O'Donovan, 2/26)

The New York Times:
Once Again, Push For Gun Control Collides With Political Reality
Here’s how significant things don’t get done in Washington even in a moment of crisis and opportunity. The president throws out a hodgepodge of ideas, thoroughly confusing both sides about what he really supports. Senate Republicans, grappling for an answer that responds to public clamor but doesn’t alienate their conservative base, would prefer instead to focus on a small fix unlikely to satisfy many people even if it could overcome internal divisions. House Republicans say they will wait to see what the Senate does — though history has shown that can be a very long wait. Democrats push for a broad debate that Republicans want nothing to do with. (Carl Hulse, 2/28)

Los Angeles Times:
Treating And Housing The Mentally Ill Is Harder Than Jailing Them. But It Might Actually Work
If only we could make Les Jones’ story more commonplace. As the 62-year-old Texas native leans back from his desktop computer in his small apartment, he details his journey from a successful radio career to a mental breakdown, to the streets, to shelter and finally to treatment and a healthy, happy life in this tidy complex at perhaps the most enviable corner of Santa Monica, steps from the Third Street Promenade, a short walk to the beach. “I am one verse,” Jones says of the composition of the American population of the mentally ill. “There are others. Modern treatment of mental illness produces miracles. It literally saved my life.” (2/28)

Los Angeles Times:
Are Hollywood Movies Teaching Men And Boys That Predatory Behavior Is OK?
We've all sat in horror these last several months as some of the most influential and powerful men in the movie business have been accused of sexual abuse, harassment and assault. Yet, as a film buff, reading account after account of predatory men behind the scenes in Hollywood, it's been impossible to ignore how similar the predatory behavior we've been reading about is to what often see celebrated on the big screen. (Jonathan McIntosh, 3/1)

MarketWatch:
Republicans Will Lead Us Unwittingly To Single-Payer Health Care
Congressional Republicans have adequately demonstrated they are fiscal conservatives when Democrats occupy the White House, but find big deficits all too seductive when they enjoy the levers of power in both political branches of government.Up next, the GOP will try to fix the most unfixable of liberal contraptions — the Affordable Care Act. By revoking the individual mandate as part of their tax cut, Republicans set in motion a process that could put the Democrats in charge for the next decade. (Peter Morici, 2/27)

The Hill:
Veterans Choice Applies To Types Of Treatments, Not Just Access
In discussing veterans’ health care, one of the most commonly used words is “choice.” Most often, choice is used in the context of allowing veterans to seek care within their community, rather than at a VA facility. However, there are other important aspects of choice that are less discussed, but equally important when it comes to veterans’ health care is the choice of treatment options. (Rory E. Riley-Topping, 2/28)

Boston Globe:
Balance On Cannabis May Lead To Answers On Opioids
The United States is the midst of an opioid crisis. Ninety Americans die each day from opioid overdoses on prescription opioids, heroin, or fentanyl, and Massachusetts has not been spared. Many states are using the best available tools to battle the crisis, with an eye on developing better science and policy to put an end to the crisis. As more states implement either medical or legalized recreational cannabis policies, they should consider whether cannabis can play a role in the opioid crisis. (Kevin P. Hill, 3/1)

The New York Times:
The Cruel Ploy Of Taking Immigrant Kids From Their Parents
The Department of Homeland Security may soon formalize the abhorrent practice of detaining the children of asylum-seekers separately from their parents. ...This country’s medical and mental health organizations have rightly recognized the trauma of this practice. The American Academy of Pediatrics has condemned immigrant family separation, and family detention overall, as “harsh and counterproductive.” The American Medical Association has denounced family separation as causing “unnecessary distress, depression and anxiety.” (Dora Galacatos, Alan Shapiro and Brett Stark, 2/28)

New England Journal of Medicine:
Can Work Be Required In The Medicaid Program?
On January 11, 2018, a new policy encouraging states to develop work requirements in their Medicaid programs was issued by the Centers for Medicare and Medicaid Services (CMS). Under this policy, states can require nonelderly, nondisabled adults to work or engage in community service to qualify for Medicaid coverage, unless they are deemed medically frail or have a substance use disorder. ...The question is whether CMS has the authority to make such a shift, which will allow states to create barriers to enrollment for eligible Medicaid beneficiaries. (Nicole Huberfeld, 3/1)

New England Journal of Medicine:
Vaccination Without Litigation — Addressing Religious Objections To Hospital Influenza-Vaccination Mandates
In April 2016, the Equal Employment Opportunity Commission (EEOC) sued Mission Hospital, a large North Carolina health system, over its denial of employee requests for religious exemptions from an influenza-vaccination requirement. The lawsuit, which alleges religious discrimination in violation of Title VII of the Civil Rights Act of 1964, settled in January 2018, with Mission agreeing to both compensate the employees and revise its policy on vaccination exemptions. ...Influenza-vaccination mandates for health care workers represent good policy, but heavy-handed, context-free implementation does not. Hospitals that pursue an inflexible approach to minimize religious exemptions are likely to find that the juice isn’t worth the squeeze. In contrast, well-drafted and reasonably applied policies should avoid or withstand legal challenge, while also protecting patients. (Douglas J. Opel, James A. Sonne and Michelle M. Mello, 3/1)

San Antonio Press Express:
Straus Is Right, Investigate State Health Agency
What is going on at the Texas Health and Human Services Commission? A recent state audit found Superior HealthPlan, an insurance company that contracts with HHSC, spent nearly $30 million in “unallowable” bonus and incentive payments. That allowed Superior to understate profits, the audit said, warping what it might owe taxpayers under a profit-sharing agreement. In other words, contract requirements were ignored in a way that benefited Superior and cost taxpayers. (2/27)

Kansas City Star:
Should Harrisonville Recognize Student Who Committed Suicide?
The last time they counted, 10,042 people lived in Harrisonville, Missouri. More than twice that number, some 23,000, have signed a petition urging officials at Harrisonville High to have a heart. They want school officials to call the name of a member of the Class of 2018 who committed suicide two years ago at this year’s graduation, as her family is pressuring them to do. But those 23,000 people are not necessarily right. (2/28)